“The chances of an elderly person in this condition with septic shock surviving 24 to 48 hours are slim — about 10-20 percent, but that would be in an intensive care unit with very aggressive treatment,” said Dr. Gianni Angelini, a professor of cardiac surgery at Bristol University in England.
…
“If he is not going back to the hospital, they must realize there’s not much point in doing anything more heroic. It indicates they are preparing for him to die peacefully at the Vatican,” Angelini said.
“The chances of an elderly person in this condition with septic shock surviving 24 to 48 hours are slim — about 10-20 percent, but that would be in an intensive care unit with very aggressive treatment,” said Dr. Gianni Angelini, a professor of cardiac surgery at Bristol University in England.
…
“If he is not going back to the hospital, they must realize there’s not much point in doing anything more heroic. It indicates they are preparing for him to die peacefully at the Vatican,” Angelini said.
This has nothing to do with feeding and hydration. Why is it that those advocating we let people starve to death can not honestly recognize the difference that that the Church instructs us to recognize? The document clearly explains it.
God Bless,
Matt
I like new CDF documents!
They make me happy.
I have a whole book of them (mostly in Latin and other non-English languages, unfortunately), of all the CDF documents from Vatican II through the end of John Paul II’s reign.
I expect to be especially happy when the new bioethics document they’re working on comes out.
The current document gives us a preview of a topic they may take up in the forthcoming one. The current document consists of a pair of responses to dubia submitted regarding whether you can yank artificially administered food and water from someone in a "vegetative state."
And the answer is . . .
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SPOILER SPACE
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No! You can’t starve someone to death just because they have impaired mental abilities or have lost consciousness!
So there!
Take that, Evil Medical Establishment!
There are, of course, cases when the administration of food or water actually harms the patient (because the body has lost the ability to assimilate them), but that’s a different situation. It isn’t the case that just because someone’s lost mental function that it’s okay to starve them to death.
HERE’S THE DOCUMENT. [Evil File Format: .pdf warning!]
Oddly, it was released with an unsigned commentary amplifying on the responses. That’s something the CDF has taken to doing in some cases lately, which is kinda weird since the commentary has ambiguous doctrinal status, but it seems to be a mode of operation the body is trying out. Such commentaries seem to have a status of "not official Church teaching, but trying to help explain official Church teaching and the reasons for it."
AND HERE’S SOME COMMENTARY ON THE RESPONSES AND THE COMMENTARY FROM THE NATIONAL CATHOLIC BIOETHICS CENTER.
P.S. Goat stealing is also immoral, but the new CDF document doesn’t go into that. Maybe a future one will.
Author: Jimmy Akin
Jimmy was born in Texas, grew up nominally Protestant, but at age 20 experienced a profound conversion to Christ. Planning on becoming a Protestant seminary professor, he started an intensive study of the Bible. But the more he immersed himself in Scripture the more he found to support the Catholic faith, and in 1992 he entered the Catholic Church. His conversion story, "A Triumph and a Tragedy," is published in Surprised by Truth. Besides being an author, Jimmy is the Senior Apologist at Catholic Answers, a contributing editor to Catholic Answers Magazine, and a weekly guest on "Catholic Answers Live."
View all posts by Jimmy Akin
There is one thing about this document that I like. It is short and sweet.
Jimmy? “Goat sealing?”
That one passed me on both sides….
Jimmy? “Goat sealing?”
That one passed me on both sides….
Typo. He meant “Goat Stealing” — see the post below this one.
As for the rest…it’s disappointing that we need to be told not to starve each other.
Cath Audio et al,
What is so disappointing is that the US Bishops had to go to the point of asking the Vatican in the first place after the info that was given by John Paul II and I think Cardian Ratzinger at the time of Terry Schiavo’s murder. They weree perfectly clear that food and water were ORDINARY and NECESSARY care, even if given thru a tube. And that it was NOT OK to consider food and water to be extra-medical treatement which could be witheld.
Within a few days of JP’s letter explaining the doctrine, I checked again, the USCCB’s site regarding this and it still said that food and water were considered to be extra medical treatment which could be witheld and my heart just ust sunk. I thought, Oh No, they are even goig to fight the Vatican on this too. And I’ve checked it since and it is the same, altho I have not seen it within the last month or so, so it might have been changed since this document has come out.
Hopefully it will have been changed and the bishops will get up the gumption to fight for the life of these poor folks instead of putting out press releases of how it is so wrong for the state to enact the death penalty, etc, etc. etc.
God bless and please God, help our bishops be the shepherds that you gave them the command to be.
No, no. “Goat sealing” refers to the practice, often engaged in by noble medieval youth, of boisterously running into the neighboring nobles’ fields at night and affixing their family seal to their rivals’ goats. This was a source of merriment for the peasants on the lands of the rival lord, who on waking in the morning would find their master’s livestock prancing around the meadow with red wax and long ribbons trailing behind them. “He really got his goats sealed” became an early expression for serious defeat on the battle- or soccer field.
One of the earliest animal-rights organizations, founded by a group of forward-thinking Franciscans, earnestly opposed this practice, which involved applying hot wax to the skin of the poor animals. As agricultural practices advanaced and the keeping of cattle became more common, this pranksters’ tradition evolved to a form more recognizable to the modern observer . . . .
How sad that people have to be told that it is wrong to starve someone to death. How much sadder that our bishops still don’t seem to know that it is wrong.
Lethal injection-wrong….forced starvation-well, that depends upon the circumstances and the situation…there are instances when it might be a regrettable choice which must be made, blah, blah, blah
Jimmy is already the #2 google hit for “Goat Sealing”
JIMMY, whatever drugs you are on…share!
AKA…you are sounding giddy like a man in love…yes?
Let first note that I am entirely in agreement with the document. I ask my question only to be clear.
Our pastor announced this Sunday, in regards to this document, “Rome has spoken…”
Does this document then carry the weight of moral certitude? Or is it theoretically possible that it could be modified, corrected or annulled?
Note how I subtly change the conversation from pro-life issues to infallible questions. Feel free to ignore this post.
BTW: Thank you Francis, I knew nothing about goat sealing before today. I can hardly wait to go home and tell my children. Tell me can I find this wonderous information on Wikipedia or, perhaps, somewhere in my goat barn? (Is the phrase, “Get your goat” then in reference to removing the seal?)
So this is branding other people’s goats with one’s own brand? Sounds like rustling to me. Where’s Judge Roy al-Bean when you need him?
AFAIK, the answer is “Yes.”
The “or” above notwithstanding, the two propositions are not exclusive alternatives… and in fact both are correct, to the best of my knowledge.
1. The teaching does carry the weight of moral certitude. It does not call for the certainty of faith which admits no error, since the statement is not an exercise of the extraordinary magisterium. We can be morally certain that the teaching is correct.
2. Theoretically, yes, the teaching could be modified, corrected or annulled. But only if it is wrong, which it is not (see 1 above). If it is right, which it is, then of course it cannot actually be modified, corrected or annulled.
Good grief, Jimmy: give the “evil file format” a rest. PDF, while not a public standard, is an OPEN standard, and there are several open source or freeware readers (and writers) for the format available. Look into Foxit Reader or Sumatra PDF. HTML is an utterly inadequate alternative, as it does not preserve pagination and formatting.
One of the less understood implications of witholding hydration and nutrition is that the patient slowly starves and dehydrates to death. They will look gaunt and emaciated, perhaps showing other physiological responses indicating their hunger and thirst. This is harrowing for the relatives, medical staff and perhaps the patient.
As this practice becomes more widespread and ‘noticed’ by enough people, the next question will be, “why let this person die slowly and distressingly? Wouldn’t it be kinder to give them a single, painless lethal injection?”
Whatever one considers to be “extraordinary means”, remember the slippery slope we tread …
Nothing on goat stealing? Nothing at all?
Typical Rome. Avoid the hard issues. Pretend they’ll just go away.
Well, goat stealing won’t stop until we, the ordinary people in the world, PUT a stop to it.
…So this is branding other people’s goats with one’s own brand? Sounds like rustling to me. Where’s Judge Roy al-Bean when you need him?…
I guess you haven’t heard, Bill…the Judge was lynched last night by a gang led by that evil Reverend James White!
…So this is branding other people’s goats with one’s own brand? Sounds like rustling to me. Where’s Judge Roy al-Bean when you need him?…
I guess you haven’t heard, Bill…the Judge was lynched last night by a gang led by that evil Reverend James White!
…So this is branding other people’s goats with one’s own brand? Sounds like rustling to me. Where’s Judge Roy al-Bean when you need him?…
I guess you haven’t heard, Bill…the Judge was lynched last night by a gang led by that evil Reverend James White!
Thanks SDG. Does the same apply to sealing goats? And if so does this extend to sealing goat cheeze? It’s all just too confusing for me.
I’m no expert like SDG but I would think that SEALING goats is a dastardly act punishable by a good flogging.
I’m no expert like SDG but I would think that SEALING goats is a dastardly act punishable by a good flogging.
I’m no expert like SDG but I would think that SEALING goats is a dastardly act punishable by a good flogging.
I think Francis is pulling our legs. Turn out goat sealing is ancient, dating well before the middle ages. See the 6th picture down the slow loading page.
http://www-news.uchicago.edu/releases/05/051216.hamoukar-photos.shtml
Perhaps Jimmy was just “kidding” about the goat sealing…though at our house we prefer to use vacuum sealing of our products to keep them fresh longer. Then again if Ed Peters says we need to put a stop to it maybe we need to get another seal of approval from Rome?
I agree with others…it’s all too cornfusing for me
TomA has spoken. Amen!
TomA has spoken. Amen!
TomA has spoken. Amen!
A new motto for a Sundial….
SIGNAVERIS HIRCUM
Seal the Goat!!
SIGNAVERIS HIRCUM
You’ve broken the great secret Masonic seal!
SIGNAVERIS HIRCUM
You’ve broken the great secret Masonic seal!
SIGNAVERIS HIRCUM
You’ve broken the great secret Masonic seal!
Does the ability to assimilate refer to the function of the stomach and the intestines, or would it also refer to the ability for the bloodstream to assimilate nutrition and hydration provided through an IV?
It was posted:
” have a whole book of them (mostly in Latin and other non-English languages, unfortunately), of all the CDF documents from Vatican II through the end of John Paul II’s reign.”
Question-do not any documents or church teachings count before Vatican II and JPII’s “reign” or for fear of contradiction we only want to start with 1962?
Just a thought
Yes, unfortunately I was totally making that up about goat sealing. Sorry for the confusion. I hope it raised some smiles.
You see, John? You only have ONE SUBJECT — how the Church has gone off the rails. It’s the ONLY thing you EVER talk about. THAT is why you are a hobby-horser.
THIS thread has NOTHING to do with Rad-Tradism, but you’re just incapable of not making that the subject of EVERY discussion.
You didn’t even engage the subject of the post in passing or tangentially, the way a Protestant like Jeb might have done.
I think Tim J may be right — perhaps Jimmy needs to disinvite you to participate on the blog.
Right. Heaven forbid we actually organize Church documents in volumes that begin at each Council. That might imply that previous ones didn’t count.
If you’re going to bring your hobby horse, take some riding lessons first.
How do you organize YOUR CDF documents, John? I assume you have read them all.
Jimmy, Jimmy – you’re going to have to accept PDF files at some point. They’re not going away. Just give it up and come to the PDF side. You’ve got little choice. Resistance is futile.
“I am Locutus of John. Resistance is futile.”
Take care and God bless,
Inocencio
J+M+J
You see, John? You only have ONE SUBJECT — how the Church has gone off the rails. It’s the ONLY thing you EVER talk about. THAT is why you are a hobby-horser.
SDG —
So true!
Among so many other examples, there was a thread concerning Contraception and even there John bursted out of nowhere blaming Vatican II for the same litany of offenses against “His Holiness”, JTnova!
/end of tangent
John, you don’t even have your historical dates straight on this one.
Not a common reader of the comments of all posts and unfamiliar therefore with John, it strikes me that my relevant and important question was ignored while his got several replies (though no answer). So I’ll attempt to answer John. “John, I can’t speak for Jimmy, but it would seem to me that it would be quite difficult to thoughtfully and efficently process all documents in church history. An extremely bright theologian such as Jimmy would potentially better serve the Catholic community by analyzing and commenting on more recent documents, which the Holy Spirit through the Chuch has revealed to be related to more timely (perhaps more controversial and thus relevant) issues.”
Others-It would seem more appropriate to either ignore John’s question or reply with a brief, charitable answer rather than attack his potential motivations.
Anon,
Just FYI John has been warned about his hobby horse three times by Jimmy. So his motivation is obvious.
Take care and God bless,
Inocencio
J+M+J
Well, that would be good advice, Anon, if we were dealing with someone who is open to charity.
With respect – we ARE familiar with John. We are not questioning his motivations… we KNOW them backward and forward. He has trumpeted his opinions in the combox ad nauseum.
If only his motivations WERE in doubt!
In charity, John needs to be given the internet equivalent of a kick in the pants… for his own good.
Anon, I have to go back and give the document a more thorough reading which would mean more time than I have at the moment.
Your response to John was similar to what I was thinking. I’m not sure that the earlier ones are even electronically accessible.
As for ignoring John – we’ve tried. The problem is that John’s comments have been known to cause confusion to others, including some in the process of learning about the Catholic faith. Usually I try to only correct his inaccurate information. Not only has there been a history with John but yesterday he made a personally slanderous comment. So patience with him is a bit short at the moment.
“The problem is that John’s comments have been known to cause confusion to others, including some in the process of learning about the Catholic faith.”
Good answer Mary Kay. Thanks. I now understand.
Johns hobby horse has entered a permanent vegetative state…
Do not feed and water the hobby horse…
Good question. The CDF document doesn’t mention intravenous nutrition and hydration, although it does mention “natural or artificial means.”
Based on the reasoning presented in this document, it would seem that withholding intravenous nutrition and hydration for a therapeutic reason, where to administer it would do more harm than good — for example, in the case of a dying patient with severe ascites for whom any additional fluid would only aggravate the condition – would be permissible.
However, I can’t see that to withhold intravenous nourishment and water where the body is capable of assimilating and benefitting from it would be permissible.
SDG-Thanks. That’s a quite helpful analysis.
Anon,
“Does the ability to assimilate refer to the function of the stomach and the intestines, or would it also refer to the ability for the bloodstream to assimilate nutrition and hydration provided through an IV?”
The commentary for the document seems to answer your question in principle if not directly.
Take care and God bless,
Inocencio
J+M+J
I rather thought “goat sealing” referred to some bizarre schismatic practice of confirming goats in the Catholic Church… “Be sealed with the Holy Spirit”…but Francis’ answer is much better. 😉
Goat sealing is alright, but goat TIPPING is more fun.
Bill,
They say that judge Al-bean was asked once why he had just sentenced a killer to jail while sending a breaker of certain caprid-related statutes to the gallows. He answered, “Around here we have some men that need killin’, but we don’t have any goats that need sealin’!”
It would be hard to read any CDF documents from before Vatican II, because there aren’t any. Before 1965 it was called the Sacred Congregation of the Holy Office.
When most people think of this moral issue they think of someone like Terry Schiavo, a young healthy person with brain damage. However when most people encounter this situation it will be with a very elderly relative who has either just stopped eating, or who has lost the ability to swallow due to a stroke.
Let’s take the first case, the old person who has just stopped eating. Perhaps it is depression, which can be treated with medication. There are a few medications which increase appetite. But suppose neither of these work, and suppose we are not dealing with a relatively vigorous older person who is depressed, say, over the loss of a loved one.
Suppose we are dealing with someone quite far along in the natural process of dying from old age. Is there a general consensus that there is such a thing as natural death, at least in our post-fall state? And that eventually our bodies wear out, and we have to die of something? Well then, the loss of the feeling of hunger and thirst is one of the natural stages of dying of old age. People who are dying this way do not suffer from hunger and thirst even though they have physical signs of dehydration. They really do just slip away. But what happens when we put in a feeding tube and start to pour in “Jevity” or similar liquid formula, at so many cc’s an hour? Sometimes the body won’t digest it at all, and it accumulates in the stomach. Or it digests it so slowly that the amount digested could not possibly sustain life. Those are fairly clear situations, but rare. More commonly, enough is digested to sustain life, but the process is slow and great care has to be taken that excessive amounts do not remain in the stomach, to be regurgitated and inhaled. In fact, even with care, this often happens, especially when the bed is, necessarily, laid flat to perform physical care.(Even though you turn off the tube feeding before you put the bed flat,if there is too much left in the stomach, this can happen.) Then the person winds up with an inhalation pneumonia, is sent to the hospital, receives antibiotics, which cure the pneumonia, but also cause diarrhea which results in skin breakdown. Or, often, the tube feedings themselves cause diarrhea which causes skin breakdown. Because urine on inflamed or macerated skin is so painful, and to keep skin dry so it can heal, an indwelling urinary catheter may be put in. However, eventually this almost always leads to urinary tract infections, as the catheter is an ascending pathway for bacteria. Often they pick up a resistant organism here; VRE, or vancomycin resistant enterococcus. But a more ordinary bug still results in further hospital stays, further antibiotics, more diarrhea, more skin breakdown. Almost all will contract “C diff” or clostridium difficile, an organism which causes incessant foul smelling mucousy diarrhea which quicly abrades skin, and can also eventually break down the lower GI tract. This organism is a spore former and its spores abound in every hospital waiting for the environment of a GI tract cleared of normal organisms by antibiotics.
Meanwhile the person is almost certainly developing contractures. Unless joints are moved passively many times each day, fingers will clench tighter and tighter until the fingernails are pressing into the palms. The knees get frozen into a bent position, until eventually the person’s heels nearly touch their buttocks. The legs become clenched together, so that separating them to clean the person properly becomes very difficult, and sometimes seems to be painful for the patient. Turning the patient from side to side to prevent decubitus ulcers on the hips seems to be painful also. Sometimes these patients die from their fourth or their tenth episode of aspiration pneumonia, when antibiotics no longer work. Sometimes they get resistant infections such as MRSA (methicillin resistant Staphlococcus aureus) in their abraded skin or in decubitus ulcers, or in the site where the feeding tube enters the abdomen. Then you see swelling and inflammation around the G tube site, and pus oozing out around it. These organisms get into the bloodstream and the patient dies of sepsis.
Scrupulous dedicated nursing care can reduce the incidence of these complications. I don’t think it can completely prevent them. And anyway, just about no one gets that kind of care. Nursing homes generally provide better turning and positioning and skin care than do hospitals, because that is what they are evaluated on and they terrorize the nursing assistants into doing it and they provide some range of motion because they give complete bed baths or hoist the patients into special bathtubs. But sooner or later these folks wind up in a hospital where the focus is acute care, the nurse is running around hanging IV meds and calling the doctor when a patient has chest pain, and doing dressings and inserting catheters etc etc, and the aides have 18 patients each, many of whom are confused in the strange setting and try to get up, and fall, and rip out their lines and tubes. In that situation the aides manage to clean up messes and deliver minimal physical care and turn the bedbound patients at the most twice a shift (although the RN will probably check off that it was done every two hours, knowing the aides did the best they could under the circumstances and in any case not having the authority LPNs do in a nursing home to insist that the aides do it. ) And, to be honest, society cannot afford any better care than this.
With ideal care, the process would take longer to happen, but still this is basically the course to be expected for a frail debilitated elderly person put on a tube feeding.
In the case of a stroke, if the person was vigorous before, the situation is somewhat more like that of a young person who is brain injured. But often strokes happen as part of the process of dying, somewhere along the continuum of ceasing to have the physical drive to eat, drink, and live. In that case, the situation is practically not much different than the scenario I described above.
It is my opinion that for people who are truly at the end of their natural life span and already frail and debilitated, tube feedings actually harm the person in most cases, and not just in those rare cases where they cannot assimilate the feedings at all. I say this after caring for many such people in both nursing home and hospital settings. I certainly don’t say it because I think the lives of the frail elderly are of less value. I don’t think we are entitled to kill people to prevent suffering (such as from cancer) that a disease process is causing them. But I don’t think we are obliged to cause them great suffering in order to prolong their lives beyond their natural span. I don’t think we are obliged to replace a month long span of dying by the cessation of eating and drinking (even though they are offered patiently)with a several year long span of dying from repeated episodes of inhalation pneumonia, antibiotic induced diarrhea, or septicemia.
Susan F. Peterson
I think Susan’s post is sensible, as per usual.
But I don’t think we are obliged to cause them great suffering in order to prolong their lives beyond their natural span. I don’t think we are obliged to replace a month long span of dying by the cessation of eating and drinking (even though they are offered patiently)with a several year long span of dying from repeated episodes of inhalation pneumonia, antibiotic induced diarrhea, or septicemia.
I believe this is one of the delicate issues here which makes this situation one that cannot be easily resolved by an overly simplistic answer in terms of wrong or right.
Now, I’m not espousing mercy killing, euthanasia or the like, but when you visit folks in convalescent homes as I have, there are those who are in such medically severe condition; who clearly would be better served by a natural passing away instead of a perpetual prison of daily agony that’s merely prolonged by the aid of mechanical devices that do not really help the patient but extend their death sentence of suffering and pain.
For those who harp on torture — this is one kind that’s unfortunately overlooked as actually being one.
Susan Peterson,
May I ask if you read the document and commentary? It clearly distinguished between those at the end of life and those supposedly in a “persistent vegetative state”. And seemed to make clear the difference between ordinary and extraordinary care.
Take care and God bless,
Inocencio
J+M+J
Unfortunately, not once does the document actually define what it is talking about, i.e. “vegetative state.” Instead, it purports, “Terminology concerning the different phases and forms of the ‘vegetative state’ continues to be discussed, but this is not important for the moral judgement involved.”
Susan has posted a thoughtful analysis which took some compassion and diligence.
However, let us not forget the slippery slope problem (see Leo’s post above).
The referenced document states that food and water are ordinary and proportionate. While we may shudder at a delayed dying process, it is something we can morally understand if we study the history of this debate. And though Susan’s mentioned conditions may or may not arise, it is not correct to say we are “replac[ing] a month long span of dying by the cessation of eating and drinking . . . with a several year long span of dying from repeated episodes of inhalation pneumonia, antibiotic induced diarrhea, or septicemia” because we do not know that to be the case, we only know that we are providing a basic human need.
In these cases, we should think of the INTENT of the food and water to be life-preserving (if they are indeed). Similarly, the INTENT of pain medication is to make a patient comfortable. This may lead to side effects which should be considered, but if proportionate we should address the patient’s pain.
“(because the body has lost the ability to assimilate them)”
HEHE!! “Assimilate them”. Like the Borg.
I like new CDF documents too! This post reminds me of William George Ward, who wanted to have a new papal bull every morning to read with breakfast. He’s described in a family biography here.
Susan,
this is one of those moral situations where “experience” with those who are suffering may be a detriment. When it comes to moral teaching in the face of real human suffering objectivity is in danger. In some situations 2 must when 1 could be killed to save the other, even 2 million should die when one immoral killing could prevent it. And so, great suffering may befall someone in order to avoid doing an immoral act.
Being “better served” does not appear in the document, and is precisely the belief that leads us to a slippery slope. The language of the document around exception:
Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.
It is my opinion that for people who are truly at the end of their natural life span and already frail and debilitated, tube feedings actually harm the person in most cases, and not just in those rare cases where they cannot assimilate the feedings at all.
Substituting our own opinion in this matter is clearly not permitted. Clearly the document is referring to a higher standard when it says that the exception is for rare cases, and not “most” cases as Susan suggests.
I also don’t see where the document makes a distinction in such cases between those at the end of life and those who are young.
God Bless,
Matt
What Matt said.
Susan, when you say “It is my opinion that for people who are truly at the end of their natural life span and already frail and debilitated, tube feedings actually harm the person in most cases,” what do you mean by “actually harm”? In what sense are they “harmed”?
Do you really mean that the presence of the tube or the introduction of food into the digestive tract itself somehow directly compromises the person’s condition or health? Or do you mean only that it prolongs their life and therefore allows them to suffer further from whatever other conditions they have?
Substituting our own opinion in this matter is clearly not permitted. Clearly the document is referring to a higher standard when it says that the exception is for rare cases, and not “most” cases as Susan suggests.
That it’s supposedly “rare” is opinion. When did the Church become medical experts?
Susan,
First, I appreciate the empathy you express in your post — I know it comes from a serious and heartfelt consideration on the matter. Furthermore, I don’t believe an orthodox Catholic would necessarily disagree with what you have written…conditioned, of course. :0)
Second, with great deference and respect, you’re confusing the issues. This document is discussing the permissibility of withdrawing a feeding tube from a person in a less-than minimally conscious state who already has one in place. This, according to sound moral principles, is immoral. They are still a person with the intrinsic dignity as such — you can’t just starve them to death because you don’t feel like feeding them any more.
This, at least in my reading, does not implicate end-of-life issues. There are various things to consider when making a judgment about initially inserting a feeding tube. Included would be (1) the expected benefit conferred and the probability of success, (2) the financial burden imposed on they payer, (3) the physical suffering/difficulties likely to be endured and (4) the psychological/dignitary harms resultant. It could well be the case that factoring in such issues raises the level of care to that of *extraordinary*, and thus not morally obligatory (at least, this is my understanding…but I don’t believe I’m wrong). In any case, such a decision is not one about which a blanket statement can be readily made — which is likely why we haven’t seen one…yet.
My two cents.
Catholic Audio, who hates calling people “vegetables” or “vegetative” as it’s highly dehumanizing and laments the usage in the CDF document.
CatholicAudio-
On my read, the document refers to both withholding and withdrawing them without much differentiation.
Also, the term “vegetative” is simply descriptive of of the state and does not have anything to do with equating humans to vegetables. The most relevant definition from dictionary.com is probably “characterized by a lack of activity; inactive; passive.” That it is dehumanizing to you may indicate simply you haven’t “assimilated” that definition of the word. However, I would agree that “calling people vegetables” would be dehumanizing.
Anon,
On second reading, I would agree with you that this *might* apply to withholding and/or withdrawing artificial forms of nutrition from those in a less-than minimally conscious state (more on the asterisked wording below). Such persons cannot be “abandoned to die”, to use the wording of the commentary.
HOWEVER, I maintain that this does not implicate end-of-life issues. To quote another Vatican document:
At the approach of death, which appears inevitable, “it is permitted in conscience to take (sic) the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life” (cf. Declaration on Euthanasia, part IV) because there is a major ethical difference between “procuring death” and “permitting death”: the former attitude rejects and denies life, while the latter accepts its natural conclusion.
(Quoted in the commentary accompaniment.)
Additionally, I don’t believe (based on the definition of “PVS” provided in the commentary) that there could be a situation where there is an initial decision to insert a feeding tube to one in a less-than minimally conscious state diagnosed as “PVS”; by definition, the condition must have existed for > 1 year. Less than one year, they’re not “PVS”. How, then, might they be provided sustenance during the year of being less-than minimally conscious leading up to eventual diagnosis? Answer: a feeding tube. If they can feed themselves, they’re not “PVS”…at least, this is my untrained understanding. Please correct me if I’m wrong.
Enjoying the discussion,
CA
In the same document you quoted, the text says, “One must always provide ordinary care (including artificial nutrition and hydration), palliative treatment, especially the proper therapy for pain, . . .” It is certainly true that the question in the CDF Document is about those in a PVS state, but based on my reading of the answer and the commentary my understandng of morality was also informed with respect to other states of life. In other words, I assumed that there indeed “implications” to non-PVS patients.
With respect to your technical clarifications and questions about initial decisions and PVS, I am ignorant of the answer.
Matt said: Substituting our own opinion in this matter is clearly not permitted. Clearly the document is referring to a higher standard when it says that the exception is for rare cases, and not “most” cases as Susan suggests.
Terry said: That it’s supposedly “rare” is opinion. When did the Church become medical experts?
The Church obviously has more than a little experience with matters of medicine, and surely the Holy See would not have made such an assertion without consulting it’s considerable resources in this area. The point that the Vatican seems to make is to set the standard by asserting that such cases are rare. The language does not sound tentative or speculative.
CatholicAudio,
Contrast your statement:
(1) the expected benefit conferred and the probability of success, (2) the financial burden imposed on they payer, (3) the physical suffering/difficulties likely to be endured and (4) the psychological/dignitary harms resultant. It could well be the case that factoring in such issues raises the level of care to that of *extraordinary*, and thus not morally obligatory (at least, this is my understanding…but I don’t believe I’m wrong).
with the actual document:
The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.
Administration doesn’t in any way imply that insertion has or hasn’t occurred as being related to the moral principles.
Anon has nailed the issue I believe ” forms of treatment ” refers to therapeutic treatments, not nourishment or hydration.
We seem to be clutching for the power to decide when a person is ready to shed this mortal coil, instead of serenely accepting the prescriptions of Holy Mother Church:
Psalm 45:11 Be still and see that I am God
God Bless,
Matt
The language does not sound tentative or speculative.
Regardless of how it sounds, it is in fact an opinion.
Terry,
The language does not sound tentative or speculative.
Regardless of how it sounds, it is in fact an opinion.
Posted by: Terry | Sep 18, 2007 9:22:45 PM
It’s an instruction from the doctrinal authority of the Catholic Church. It holds weight, it indicates that withholding of nutrition and hydration is only in rare cases where it is exceedingly burdensome. Call it what you want it is binding on the faithful to the appropriate degree.
Since you are continuing to object, perhaps you could share your own qualifications.
God Bless,
Matt
Goat stealing is one thing, but what about cow tipping?
Are alert, mentally-sound people who are terminally ill and have little time left, allowed to refuse food and/or water for themselves, not as a means to commit suicide, but because they have lost their appetite and don’t want to undergo feeding tube insertion?
While it would seem that there are possible circumstances in which an alert, terminally ill patient might find licitly refuse food as excessively burdensome, I cannot see that mere loss of appetite would constitute a sufficient justifying condition. The fifth commandment imposes a grave duty — not an exceptionless duty, but a grave one — to see to one’s own basic physical needs. If any attempt to eat made one severely nauseated, it seems reasonable to conclude that one might lawfully refuse food. I don’t think I could venture a judgment whether the ordinary discomfort of a feeding tube could ever constitute sufficient warrant for refusing one. A person already in a significant degree of discomfort and sufficiently near to death might conceivably make a case that the additional discomfort of a feeding tube would be an unwarranted burden.
I have now read the document and comments.
The reference seems always to be to persons in what is termed a “persistent vegetative state.” No reference is made to the elderly who stop eating because as part of the dying process they have lost the biological stimuli of hunger and thirst.
So, does this instruction apply to them or not? I can see how many would quickly say that it is also true for them that food and water in any form are ordinary rather than extraordinary care. However,in my experience it is not rare for artificial nutrition (tube feeding) to cause them harm and pain. It is rare for the liquid feeding to be entirely unassimilated, but it is not rare for it to be poorly assimilated, and that poor assimilation leads to the distressing complications detailed in my previous comment. Most of the complications are directly attributable to the feedings, although contractures are not; they are caused by immobility.
It seems the question is, what is it that is causing the death of a person who stops eating as part of the dying process? Usually it is Alzheimer’s disease, in which this almost always happens at some point, but it also happens in people who were never diagnosed with Alzheimers, but who would just have been described as weak, frail, incapacitated, failing. Are we allowed to say that “old age” is the cause of the dying?
My qualifications for saying that it is not rare for tube feeding to be burdensome for the elderly are that I have worked in nursing homes and hospitals, first as an aide and then as a nurse, have hung many tube feedings, checked for residual(how much is left in the stomach), have put in nasogastric tubes to begin tube feeding and checked for proper positioning of the tube. I have turned and positioned and cleaned many many people on long term tube feedings.
For saying that the response of the very elderly to tube feeding is different from that of say, young head trauma victims, is that I worked for about half a year in a head trauma rehab. At one point I worked in a wing with people who were no longer expected to recover, who were just being maintained, where I prepared and hung 20 tube feedings twice a shift. (There they feed by bolus rather than by continuous pump.) These people’s bodies in general assimilated the food, they did not have excessive diarrhea, and with normal turning and positioning they did not have skin breakdown. The picture with people who are 80 or 90 is very very different, and I think that I can validly give an opinion that tube feeding most often, rather than rarely, harms them.
Susan Peterson
Susan,
as I previously stated, sympathy is not the primary concern as it often leads to subjectivism.
It seems the question is, what is it that is causing the death of a person who stops eating as part of the dying process? Usually it is Alzheimer’s disease
The cause of a person who stops eating, as the document and other Church documents, as well as can easily be discerned from the physical symptoms are starvation/dehydration. We can’t starve people, it’s as clear as that.
We need to focus more on eternal souls here, and not on trying to work our way around “mercy killing”.
God Bless,
Matt
“The picture with people who are 80 or 90 is very very different, and I think that I can validly give an opinion that tube feeding most often, rather than rarely, harms them.”
It seems from several documents that if indeed nutrition harms rather than helps someone it could be withheld. In a case where it would provide a proportionate benefit, it would be normal and basic. Age and/or whether a certain disease, however, should not be the criteria to determine that. Something like intestinal blockage and severe pain, maybe, might be indicators that a tube feeding was not a benefit and that it might in fact harm a patient.
. . . and then there would be the IV question I posed. And how do you guys do indenting and italicizing, etc.?
Anon,
indenting = < blockquote > before text and < / blockquote > after text (without spaces)
italicizing = < i > before text and < / i > after text (again without spaces)
bold = < b > & < / b >
Take care and God bless,
Inocencio
J+M+J
Very cool (though a little tedius).
I’m taking on the name Anonb so as not to be confused with Anons posting on other topics.
Matt,
I can sympathize with Susan’s concerns.
The fact is if it weren’t for the devices that are keeping the bodies of such folks alive, they wouldn’t be alive in the first place.
Now, as I’ve stated previously, I am not for mercy-killing; but I wonder for those whose lives become merely a daily agony perpetuated by the utilization of such devices that prolong the life of the body beyond natural death.
None of us would be alive without food and water, and all of us have needed to have nutrition and hydration administered to us when we could not feed ourselves, i.e., as infants.
We aren’t talking about dialysis, artificial circulation or artificial ventilation. We’re talking about food and water. Food and water are basic necessities of life, and if and when we can’t self-administer them, it’s incumbent upon other people to do it for us.
When and where either the food and water itself, or the means of administering it in and of itself, becomes excessively burdensome, then it may be licit to refrain from imposing the specific burden of such means upon the person. But it must be clearly understood that this is fundamentally different from withholding food and water because we feel that the person’s quality of life in general doesn’t warrant perpetuating.
In other words, no matter how bad the person’s condition was, if there were a way to provide nutrition and hydration in a way that was not itself unduly burdensome, it would be incumbent to do so. We don’t withhold food and water because someone’s life is a living hell — we do so only when there is no way of administering it that is not itself unduly burdensome.
Matt,
In my way of thinking, the cause of death of a very old person who stops eating and drinking because they have ceased to have the biological urge to eat and drink, is, simply, old age…or when this occurs as part of the brain destruction of Alzheimers disease, that is the cause of death.
There is a season for everything…including a season for dying. You are not killing someone who is 95 years old if you let the gradual decline of bodily systems take them. I am really offended that you are calling this mercy killing. Believe me, I have been in a situation where a doctor clearly by his prn (as needed) orders for medications was clearly indicating to the nurses that he wanted us to hasten the death of a patient…and if the orders weren’t clear enough, his statement, “If you had given her a fourth of what I ordered she would be gone by now,” made it completely clear. None of my fellow nurses would do this; we carefully calibrated pain meds to relieve pain but not actually kill the patient.
As for souls, the souls of the patients certainly aren’t in jeapordy from being allowed to die of old age rather than from having their lives artificially prolonged. In the cases I am describing, the person has alomost certainly lost the ability to pray or repent their sins, if you were thinking longer life might help them do that. The souls of the caregivers would be in trouble if they deliberately killed them. I don’t believe the caregivers sin by accepting the natural death of old age.
Matt, do you also disapprove of hospice care for cancer, where there is no further treatment that will benefit the patient? Hospice care gives pain medications and other medications to address symptoms. Sometimes they give antibiotics but usually not. They would seldom do a tube feeding or IV hydration, because in most cases these things only make the person more uncomfortable as they die. A normal degree of hydration for a generally healthy person can cause a weakened person to accumulate fluid in his lungs and have difficulty breathing. It can cause edema in tissues, thus increasing the pressure a tumor is putting on nerves, increasing pain. The person with advanced cancer has usually lost his appetite long ago and his stomach has shrunk. Tube feeding is going to make him feel uncomfortably distended, have gas, make messes which need to be cleaned up and cause discomfort and skin breakdown. Do you think we need to force people in the advanced stages of cancer to be filled with food and fluids their bodies don’t want?
Well, the situation of an elderly person who has lost the biological impulse to eat is quite similar. He is already dying; that is why he isn’t eating.
SDG, the elderly people I am talking about are seldom more than minimally alert and are almost never what we would call competent to make decisions. They refuse food by letting it dribble out of their mouths rather than swallowing. Their families are called upon to make these decisions. As for competent people who have cancer, if they feel nauseated if they try to eat, do you really think a tube pouring food into their stomach will NOT make them feel nauseated? If they are still given realistic hope that treatments may cure their cancer, they ought to try to force themselves to take nourishment. But once they are told no further treatments can help (and doctors are very reluctant to do this and often push treatment past when it makes any sense) and they have accepted that they are dying, must they make themselves feel worse by have a tube inserted through their abdomen into their stomach? (The tube down the nose and throat is temporary,only for a few days of feeding. For longer then that the tube directly into the stomach is inserted surgically.)
And anon, if you think “intestinal blockage” is the only issue, you really haven’t read my long comment above where I describe the most likely course of a very elderly person being tube fed. Someone with a complete intestinal blockage would die very soon without treatment, long before tube feeding even became an issue.People in this situation will sometimes actually have stool in their vomit. In them we put a nasogastric tube to suction to get rid of fluids accumulating in the stomach. If enemas don’t work, they need surgery. (I experienced once a person in this situation who refused surgery, despite the pleas of her husband. I think her refusal was wrong. She may have felt bad for so long she was really depressed. Should she have been declared incompetent? She was alert and oriented when she made the decision. She died in two days. This really was a form of suicide, I think.)
I don’t think it should be declared a virtue to make moral decisions about medical issues without being familiar with what the medical issues really are.
Susan F. Peterson
We don’t withhold food and water because someone’s life is a living hell
SDG:
That’s just it —
These things keep the body alive beyond natural death.
In essence, they artificially extend the life of one’s body beyond normal expiration.
For example, with all due respect to our Late Great Holy Father; just imagine —
His life could have certainly been extended by the utilization of such devices.
Yet, JP II rightfully chose a natural death.
I just wonder if we are actually subjecting people to a life sentence of torture rather than actually helping them.
Unfortunately, this is hard to decipher since in the end, it appears to depend on the subjective judgment of those who oversee their care.
Nutrition and hydration keep everyone’s body alive. Without it, you’d die just as dead as Terri Schiavo. Defending life from conception to natural death is not compatible with starving/dehydrating people to death because they’re suffering.
Objectively, if we disregard the instructions of those who are to instruct us in such matters (the Church, as guided by the Holy Spirit), the we should be concerned about our souls.
I’m not sure what this means, but I sure advocate making all medical decisions only when being familiar with what the medical issues are. We should also be informed about the morality of the decisions. Thank God that we have some guidance from the Church on these matters, given the difficuty and grave nature of the decisions in the first place.
Previous post was Anonb.
Susan Peterson,
Being familiar with the medical issues does not mean you are the best judge of the moral issues. Such judgements, faith and morals, belong to the Church. Defining food and water as ordinary care seems obvious enough.
Take care and God bless,
Inocencio
J+M+J
Nutrition and hydration keep everyone’s body alive. Without it, you’d die just as dead as Terri Schiavo. Defending life from conception to natural death is not compatible with starving/dehydrating people to death because they’re suffering.
SDG,
I believe you neglected the bulk of my comments to you.
Are you saying in essence then that the late Holy Father actually committed suicide by virtue of the fact that he forwent the option to be kept alive by the utilization of such devices that could have most certainly extended his life accordingly?
Esau/Susan/All-
Didn’t JPII have a feeding tube?
http://www.washingtonpost.com/wp-dyn/articles/A12077-2005Mar30.html
Anonb,
You forgot that had the Pope been in an intensive care unit at a hospital instead of in the Vatican, there was the chance that he could have been kept alive via aggressive treatment.
Pope Suffering Septic Shock
Esau, you’re treating all intervention as equivalent. The whole point is that administering food and water is a basic necessity of life for everyone, and a person who will die unless we feed and hydrate them is in a completely different position from a person who will die from some pathology apart from some surgical intervention to address the pathology.
We do not necessarily have to use all possible means to address all possible pathologies that may kill people; we must provide nourishment and hydration unless to do so is itself (by reason of the very food and water or the very means of providing it) excessively burdensome.
From what you’ve posted, the Pope did not decline food and water (not that I’m saying it is always wrong to do so). He declined an aggressive surgical procedure that had a slim chance of enabling him to survive a serious pathology. It is not relevant to the teaching under discussion here.
Susan,
In my way of thinking, the cause of death of a very old person who stops eating and drinking because they have ceased to have the biological urge to eat and drink, is, simply, old age…or when this occurs as part of the brain destruction of Alzheimers disease, that is the cause of death.
That’s not the Church’s way of thinking.
As for souls, the souls of the patients certainly aren’t in jeapordy from being allowed to die of old age rather than from having their lives artificially prolonged. In the cases I am describing, the person has alomost certainly lost the ability to pray or repent their sins, if you were thinking longer life might help them do that
The Church has made it clear that their lives aren’t be considered to be “artificially prolonged”. And you are not in a position to judge the capability of a soul to communicate with God, we do not know God’s plan, and so by ending someone’s life before God choses you may be harming their soul. This could be especially true if the person is in a position of despair over their pain, they could actually be desiring the shortcut you’re suggesting they be offered, which would be objectively sinful on their part.
The souls of the caregivers would be in trouble if they deliberately killed them. I don’t believe the caregivers sin by accepting the natural death of old age.
It’s obvious this situation is of serious concern to the Church, it is a matter of salvation, and your substitution of “accepting the natural death of old age” for “starving them to death” is innaccurate.
Matt, do you also disapprove of hospice care for cancer,
I’m not sure how this is relevant, but of course I approve of hospice care, unless the particular facility violates Church teaching.
where there is no further treatment that will benefit the patient?
What does therapeutic treatment that the document clearly identifies as extraordinary in such a terminal case, have to do with nutrition and hydration? Surely you can understand the difference so that we can stop with the Red Herrings.
Hospice care gives pain medications and other medications to address symptoms.
That’s good, what could be wrong with it?
Sometimes they give antibiotics but usually not.
I think this is ok, but I’m not entirely sure, it depends on the particular situation I believe.
They would seldom do a tube feeding or IV hydration, because in most cases these things only make the person more uncomfortable as they die.
This reason would violate the Church’s teaching unless death is so imminent that it would not be caused or triggered by the denial of food or hydration.
A normal degree of hydration for a generally healthy person can cause a weakened person to accumulate fluid in his lungs and have difficulty breathing. It can cause edema in tissues, thus increasing the pressure a tumor is putting on nerves, increasing pain.
If the hydration causes more damage than good to the health of the person then it is permitted to not hydrate? Is this not clear from the document?
The person with advanced cancer has usually lost his appetite long ago and his stomach has shrunk. Tube feeding is going to make him feel uncomfortably distended, have gas, make messes which need to be cleaned up and cause discomfort and skin breakdown.
Clearly not reasons to cause someone to die. You did read the document right?
Do you think we need to force people in the advanced stages of cancer to be filled with food and fluids their bodies don’t want?
None of this document addresses the issue of forced feeding against a person’s actual resistance, although the moral prescriptions would apply to the individual involved. The culpabiliy of care-givers resides in their actions when the patient is not resisting. Their bodies’ don’t want? Can you clarify this?
Well, the situation of an elderly person who has lost the biological impulse to eat is quite similar. He is already dying; that is why he isn’t eating.
Again, if death is caused by means other than starvation or dehydration, it’s another issue. By the way we are ALL dying, just some sooner than others.
SDG’s responses to this are 100% on.
Anonb,
You forgot that had the Pope been in an intensive care unit at a hospital instead of in the Vatican, there was the chance that he could have been kept alive via aggressive treatment.
The document specifically addresses those in a so called vegetative state. It really doesn’t say if or how it applies to the kinds of situations I raised here. You seem to think it automatically extends to them, but I don’t.
Susan Peterson
Susan Peterson,
I think SDG’s Sep 19, 2007 3:02:51 PM comments explain Catholic teaching very clearly and concisely in regard to these issues. I would suggest reading them and then comparing them with the CCC #2277-2279.
Take care and God bless,
Inocencio
J+M+J
From what you’ve posted, the Pope did not decline food and water (not that I’m saying it is always wrong to do so). He declined an aggressive surgical procedure that had a slim chance of enabling him to survive a serious pathology. It is not relevant to the teaching under discussion here.
SDG:
It is by the same token when you consider that there was refusal of medical attention and instead of said medical attention, an opting for natural death.
Why is it that those advocating we let people starve to death can not honestly recognize the difference that that the Church instructs us to recognize?
There’s a distinct difference between forcing a person to die (which is obviously the equivalent of murder) and allowing a natural death.
The former is indeed a mortal sin and those who subscribe to mercy-killing may indeed be signing the death warrants and, therefore, committing murder in this regard.
Now, if you consider the latter a mortal sin; then you are accusing the Vatican of having committed a mortal sin in having allowed His Holiness a natural death instead of receiving medical attention in the intensive care unit of a hospital.
Esau,
non-sequitor. This is not about the administration of therapeutic medical treatment.
God Bless,
Matt
This is not about the administration of therapeutic medical treatment.
You do not consider feeding and hydration via artificial means “therapeutic medical treatment”?
Esau, is a hungry newborn in need of “medical attention”? How about a paraplegic that needs you to spoon food into his mouth? A feeding tube is just an extension of that, an accomodation of the individual’s need for nutrition and hydration, a basic human need. Without that, anyone will starves to death.
Septic shock is a pathological condition. Hunger and thirst are not. Surgery to treat sceptic shock is in a different category from providing food and water. This is the Church’s teaching. I keep saying the same thing over and over. I don’t know why it seems to be a problem.
No, I wouldn’t. It is neither “therapeutic” or “medicinal” because administering food and water is not ordered toward treating or curing a disease. It is addressing the body’s basic need for nutrition and hydration.
Matt, SDG:
The point of the matter is if the Vatican rightfully allowed Pope John Paul II the benefit of a natural death, then why shouldn’t the same benefit be extended to the elderly whose bodies are only artificially sustained by the use of such devices when really they’re already at the point of death?
Doesn’t this strike anybody as actually being a form of torture? One that is perpetuated daily by those who keep such elderly folks alive by these devices whose purpose it seems is to prolong the agony of these patients who are already in such dire condition and, all in all, dying?
Don’t they deserve the benefit of a natural death as did His Holiness?
Esau,
The point of the matter is if the Vatican rightfully allowed Pope John Paul II the benefit of a natural death, then why shouldn’t the same benefit be extended to the elderly whose bodies are only artificially sustained by the use of such devices when really they’re already at the point of death?
No, that is not the point.
the provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment. Its use should therefore be considered ordinary and proportionate
“Roma locutus est, causa finis est”
Matt
Esau, why do you complain that I don’t address your points, and then when I do you don’t address mine? You just keep restating your position and ignoring my objections to it, even though I am addressing your claims.
You keep saying things like “the benefit of a natural death.” Your whole line of thought presupposes that “natural death” can be seen as a positive good, a “benefit,” an “end” to which our acts can be ordered as means.
This is where you go wrong. Your argument is based on a presupposition that is wholly contrary to the Church’s ethic of life. Death can never be either the end of any licit act, nor the means to any legitimate end. Death can only ever be the foreseen, accepted but unwilled consequence of some licit act which is itself ordered toward some other good.
For instance, if a dying patient in severe respiratory distress is in great physical pain, it may be permissible to administer a palliative drug such as morphine in order to manage the pain, even if the morphine might also have the foreseen, accepted but unwilled consequence of suppressing the nervous system and thus further compromising the person’s respiratory condition, thereby bringing about death that much sooner.
In other words, one does not have to force the patient to endure the maximum pain in order to prolong death for the longest possible time. One can act toward a licit end — treating the person’s pain — in spite of the potential consequence of shortening the person’s life.
However, one could not administer a dose of morphine calculated to suppress the nervous system and compromise the person’s respiration in order to bring about the person’s death. Likewise, if there were another way of achieving the same palliative care without suppressing the nervous system, it would be necessary to use this rather than the other.
The question is not whether, or how, to “allow a natural death.” The question is: What means of seeking to sustain life or forestall death are obligatory, and which are not?
The Church finds that there is a difference between
allowing a person to die of a serious pathological condition that is killing him, and which could possibly be treated by some aggressive therapeutic intervention, and
allowing a person to die of starvation and dehydration rather than providing nutrition and hydration.
The Church finds that treating pathology is different from providing nutrition and hydration. The latter is more basic and necessary than the former. Even in cases where therapeutic treatment of pathology may not be necessary, providing nutrition and hydration still is, unless either the nutrition and hydration themselves or the means of providing it are overly burdensome. Simply because the person’s general quality of life is too low and we want to allow them “the benefit of a natural death” isn’t going to cut it.
You can continue to cite JP2 and “the benefit of a natural death” all you want, but these points have been quite clearly addressed. Feel free to respond to my formulation of the Church’s position if you want, but please don’t keep repeating the same points I’ve already addressed.
You’re right about that, Matt. But I agree with Esau insofar that before this document, I didn’t think it was clear whether the making the initial incision and insertion of a feeding tube into a patient’s throat or stomach or wherever was “ordinary” care. In most circumstances feeding someone is an ordinary activity. In those circumstances, I wouldn’t have been so sure. Maybe that’s just because I was ignorant about what the Magisterium had previously said on the topic, but at any rate I don’t think it’s an open-and-shut logical case. In other words, an authoritative articulation of the doctrine was needed, and now I am thankful that we have one.
Continuing to address Esau’s comments:
If the actual feeding tube, or the actual introduction of food or water, is itself a source of significant distress, then that could be akin to torture, and could be something that could (depending on the circumstances) be lawfully discontinued.
However, if the cause of the person’s suffering is neither the actual food and water nor the means of providing it, but some pathological condition that is slowly killing them, we can do all we can to make them as comfortable as possible, but we cannot starve/dehydrate them to death in order to end their suffering. That is treating death either as an end in itself, or at least as a means toward the end of stopping their suffering.
As long as we can feed and hydrate them without thereby causing them an undue burden of suffering or harm — suffering or harm directly related either to the nutrition and hydration or to the means of administering it — we must continue to do so, even if they are suffering.
SDG,
well said. Note that the document specifically states that cases which the suffering due to the use of artificial forms of feeding would justify discontinuation are rare, indicating that they are certainly more than “discomfort”.
God Bless,
Matt
Thanks SDG for patiently responding to my comments.
However, if the cause of the person’s suffering is neither the actual food and water nor the means of providing it, but some pathological condition that is slowly killing them, we can do all we can to make them as comfortable as possible, but we cannot starve/dehydrate them to death in order to end their suffering.
However, the issues are left unresolved.
Aging is a natural condition of the human person.
These medical devices (those we speak of here) in the circumstances that have been raised merely delay the natual expiration of the human individual.
That is, they artificially prolong the life of the body.
But therein lies the rub in the fact that the elderly folks who are already dying have their moment of death unnaturally extended to the point where they’re not given the benefit of a natural death.
It almost reminds me of Prometheus who was forced to suffer endless torture in the Caucasus mountains by the eagle that kept preying on his liver; yet, he couldn’t die since his liver was ever-regenerating.
That is, instead of allowing the natural course of life as intended by God to occur for these old people, it seems every artificial means is being taken to ensure that the moment of death for these folks becomes an agonizing endless torment instead of being one of a natural instance; a death that would be the natural result of an advanced right old age.
Esau,
That is, instead of allowing the natural course of life as intended by God to occur for these old people, it seems every artificial means is being taken to ensure that the moment of death for these folks becomes an agonizing endless torment instead of being one of a natural instance; a death that would be the natural result of an advanced right old age.
Not every, as you well know but specific means. Can you cite something in support of this position, or is it purely a personal opinion?
God Bless,
Matt
“These medical devices (those we speak of here) in the circumstances that have been raised merely delay the natual expiration of the human individual.”
Well, strictly speaking, that’s what happens every time we eat. Eating delays the natural expiration of human individuals. Hopefully, it delays it for a number of decades. Delaying death (all else aside) is an objective good.
Feeding people can’t really be regarded, in my view, as something extraordinary or artificial. Certainly when you look at the realities Susan so helpfully outlined, you understand that forcing food can sometimes cause more misery than it alleviates because the body can not digest it properly – but in that case you would not be withholding food in order to hasten death, you would be withholding it because it was harmful to the patient. In that case, the law of double-effect applies (I think, help me out here).
I do see that a loss of appetite can be a very natural aspect of the process of the body shutting down, but that can’t always be known with certainty.
I might hope that, instead of force-feeding me, caregivers will leave me to live out my last few days in peace, but at the same time, if I can prolong my life by taking food, this might be my duty before God, regardless of the suffering of my days. I hope – I pray – I will have the courage to accept what suffering my death brings with grace and dignity.
There are many people, I’m sure, for whom every morning means only more suffering, but that does not mean that they should take steps to shorten their life. It does not even mean that they can honorably avoid what means are available to prolong it.
Each day, God gives me my assignment. It is not for me to decide to limit my days because I don’t care much for the assignment. If food is refused or withheld FOR THE PURPOSE of hastening death, this is contrary to natural law, EVEN if death is already imminent.
I may be tempted to regret these opinions, one day, when I lay prostrate in some dim convalescent home, but I hope I will stick it out with fortitude every day God gives me.
Food and water do not “artificially” prolong the life of the body.
A feeding tube is “artificial,” I grant you. So is a spoon. If you need me to spoon food into your mouth, am I “artificially prolonging” the life of the body?
You speak of “elderly folks who are already dying.” I ask you: Why are they “already dying”? Because they are hungry and thirsty, in need of nutrition and hydration, or for some other reason?
If for some other reason, then nutrition and hydration will not “artificially prolong” their lives at all. You can nourish and hydrate a cancer patient as much as you want, and it won’t “artificially prolong” their life one whit beyond the course of the cancer’s deadly progression. When the cancer kills them, it kills them, nutrition and hydration notwithstanding.
Indeed, as death approaches, the time will come when their body can no longer assimilate nutrition, and then the time has come to stop providing it. Possibly even before, if the means of providing it become excessively burdensome.
Until that point, however, if you stop feeding and hydrating them, then it is not a case of a patient who is “already dying.” It is a case of you starving and dehydrating them to death by not providing the nutrition and hydration that a pro-life ethic requires we provide to those who cannot administer to themselves the food they need.
A patient dying of cancer is one thing. We cannot stop the cancer. A patient starving/dehydrating to death is something completely different. We are not authorized to permit the latter death just because the former death is coming anyway.
What on earth are you talking about? “Every artificial means”? Are we talking about the Church’s teaching, or something else?
The Church does not remotely require “every artificial means.” It does require us to provide nutrition and hydration. There is no slippery slope from “nutrition and hydration” to “every artificial means.” I don’t know why you want to steamroller over the Church’s distinction on this point, but there it is.
By what criterion have you determined what is “intended by God” in this case? Because some patients cannot feed themselves, how do you conclude that God does not wish us to feed them?
If a newborn baby is abandoned and starves to death, is that “intended by God”? After all, if God wanted newborn babies to eat, why should they not be born self-sufficient? If your house catches on fire and you cannot escape, is it intended by God that firemen need not bother trying to rescue you? If you have a ruptured appendix, is it intended by God that surgeons should not try to save your life?
SDG:
I was speaking strictly with regards to elderly folks; in particular, those who are in well advanced age.
Please note my previous comments:
The problem I see is that medical technology has done good in that they have extended the normal life span of the individual; however, it has also complicated matters of natural death (here, I am strictly speaking of the elderly — those who are at a well-advanced age).
That is the heart of the issue which I am speaking about.
When a person is already in their late eighties or even in their nineties (and, for some, nearing or even over their hundred), it seems against that natural course of human life as intended by God (here, I speak of the natural aging of man and death being the natural result), to prevent the natural occurence of death at such an age by forcing the human body to live more than what is already its limit just because we have the technological means of sustaining the body.
At this particular stage of human life where death is indeed the natural consequence; we seem to not want to allow what God has intended as being the natural course of man here.
“it seems against that natural course of human life as intended by God”
Read Genesis. Death was never intended by God. He did not make us to die. Death is – in the grand sweep of God’s plan – unnatural.
Esau, old pal, I don’t see wher your post above deals substantively with any of SDG’s objections, that is; you must distinguish between dying of “x” (whether it be old age, cancer or what have you) and dying of starvation and malnutrition. You simply can NOT say, “Well, he’s dying anyway, so there’s no need to feed him”.
We just don’t allow people to die of starvation if we can help it.
I’m willing to grant that the point you raise, or something in that direction, constitutes a real issue that needs to be addressed. As should be very clear by now, I am not arguing that every medical intervention that is capable of prolonging life or forestalling death is always obligatory. Quite the contrary.
All I’m saying is that granted the problem of possibly or potentially dubious medical interventions, we need to focus our problem-solving efforts on the types of medical interventions that are actually dubious — not on the basic care that we should be providing to everyone. Administering to patients the food they need but cannot administer to themselves falls into the latter category, not the former.
It may even be true that a particular person who needs artificial nutrition and hydration is only alive today because of some other potentially dubious medical intervention, and perhaps that patient should have been allowed to die, i.e., perhaps the medical intervention in question ought not to have been carried out.
However, granted that the person is still alive, is still drawing breath and still assimilating nutrition and hydration, the answer to the other dubious intervention is not to make up for having prolonged their life with a dubious intervention by now starving/dehydrating them to death.
There are deaths that we can allow the dying to die without seeking to intervene. There are interventions that could prolong people’s lives that may not always be obligatory and sometimes might be cruel and unnecessary. But starvation/dehydration is not among the deaths that we can through our inaction allow a person to undergo. Providing nutrition and hydration to a body capable of assimilating it is not among the types of interventions that we need not carry out.
You seem fixated on the idea of not keeping dying patients alive by all possible means whatever the cost. I agree. The Church agrees. We are in agreement. Fine. That doesn’t mean we have to acquiese to starving or dehydrating them.
Are we getting anywhere?
The person with advanced cancer has usually lost his appetite long ago and his stomach has shrunk. Tube feeding is going to make him feel uncomfortably distended, have gas, make messes which need to be cleaned up and cause discomfort and skin breakdown.
Clearly not reasons to cause someone to die. You did read the document right?
Well, it depends. There is forcing someone to eat enough to stay alive, despite lack of appetite and discomfort. And then there is depriving of food on the grounds that they aren’t hungry or will suffer as a consequence of eating.
You do not have to go to extraordinary efforts to eat enough, even if not eating will weaken you, just as you can take a painkiller than you know will weaken your heart, provided your aim is to avoid the extraordinary burdens of eating that much or the proportionate suffering that eating that much will cause.
With regard to forcing someone to eat, I don’t see that the document is referring to anything like that, nor does anyone here seem to propose that. I don’t believe we are obligated to force someone who posesses their faculties to eat. In that case it seems to me to be a moral obligation on the individual to not starve to death. At some point in time if someone loses consciousness then the caregiver would be obligated to provide nutrition/hydration under the above conditions.
God Bless,
Matt
Right, Matt.
No one in possession of their faculties should be force fed… in that case, the responsibility lies with them. In the case of those who CAN’T eat on their own, however, we must always make an attempt to keep them fed and hydrated.
Mary,
I think the document suggests that feeding and hydration are not extraordinary when administered by a feeding tube or something, I’m pretty sure one could conclude that not being hungry or some discomfort is no reason not to take care of one’s body by eating.
God Bless,
Matt
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